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Home My WebLink AboutPermit Building 2006-10-02F PRING LD Buildin g/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line PERMIT NO: COM2006-01060ISSUED: 1010212006 APPLIED: 08/1612006 EXPIRES: 0410212007VALUE: $ 242,000.00 SITE ADDRESS: 3860 VITUS LN ASSESSOR'SPARCELNO.: 1702300000600 PROJECT DESCRIPTION: Garage, Living Area, and Breezeway Springfield TYPE OF WORK: Garage TYPE OF USE: New Residential Owner: Address; Contractor Type Electrical WILLIAMS ROERT G & LANESIA 3860 VITUS LN SPRINGFIELD OR 97477 Phone Number: 541-953-4987 License Expiration Date PhoneContractor OWNER CONTRACTOR INFORMATION # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Seconda ry Construction Type; # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: # of Stories: Height of Structure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building: Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: oh of Lot Coverage: NOTICE: Ft Lot Size: Sq Ft lst Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: ., R-3 U VN 32.00 Path I nla 1,936 1,936 40.00 pl\illits.o$cffii Gravel Yes Hillside Sidewalk Type: Downspouts/Drains: UNDER THIS PERMIT IS NOT DONED FOR Value REQUIRED PARKING Total: Handicapped: Compact: To Storm Sewer c0r$ME,[Lffiil,ps ls ABAN ANYof BtlttrAYoBEfll0D' DEVELOPMENT INFORMATION PUBLIC IMPROVEMENTS Notes e Ore lier Paee I of4 Date Calculated a L,av l'UILUII\U INTUT(1VIA T IUl\ Status Issued 225 Fifth Street, SPringfield' OR 541-726-3753 Phone 541-126-3676 Fax 541 -7 26-37 69 I nsPection Line Dwellings Garage V Wood Frame Garage Fee Description + l0"h Administrative Fee + 5%o TechnologY Fee + 87o State Surcharge Perm Serv/Fdr 200 amPs or less Plan Review Residential -Mechanical Issuance Fee- + l}oh Administrative Fee + 57o TechnologY Fee + 87o State Surcharge Building Permit Fixture Minimum/Adjustment Mechanical Plan Review Minor - Planning Sanitary Sewer - lst 50 Feet Sanitary Sewer - ImProvement Sanitary Sewer - Reimbursement SDC Sanitary/Storm Admin Storm Drainage ImPervious Area Storm Sewer - lst 50 Feet Vent Fan Water Line - lst 50 Feet Total Amount Paid Building/Combination Permit PERMIT NO: COM2006-01060ISSUED: 1010212006 APPLIED: 08/1612006 EXPIRES" 0410212007VALUE: $ 242,000.00 Amount Paid $99.00 I,936.00 $26.00 1,936.00 Total Value of Project Date Paid $191,664.00 $50,336.00 $242,000.00 0811712006 08/16/2006 Receipt Number l 200600000000001 275 I 200600000000001 275 l 200600000000001275 I 200600000000001275 r 200600000000001275 3200600000000000508 3200600000000000508 3200600000000000508 3200600000000000508 3200600000000000508 3200600000000000508 3200600000000000508 3200600000000000508 3200600000000000508 3200600000000000508 3200600000000000508 3200600000000000508 3200600000000000s08 3200600000000000508 3200600000000000508 3200600000000000508 Not be considered an additional dwelling unit. Storm drainage downhill to storm H2O ditchline. s6.30 $3.1s $5.04 $63.00 $243.46 $10.00 $124.92 s62.46 s99.93 $l,027.15 $42.00 $39.00 $112.00 s4s.00 $l 18.74 $l s6.l6 $49.19 $708.82 s45.00 $6.00 $45.00 8/16/06 8n6106 8n6106 8n6106 8/16/06 t012l06 r0t2l06 r0t2l06 t012l06 t0t2l06 t0l2l06 t0t2l06 t0l2l06 t012l06 r0t2t06 t0l2l06 t0t2t06 t0t2l06 t0t2l06 t012l06 r0t2l06 $3,01 2.32 Initial Review Planning Review Public Works Review Structural Review 0811112006 08n112006 0811712006 08n712006 o8fi112006 09t2512006 08/28/2006 0911412006 APP APP APP APP LLH TAJ JLP RJB To Request an insPection call the 24 hour recording at726-3769' All insp ection requested before 7:00 a'm' will be made the same worki ng day, inspections requested after 7:00 a'm' an Reviews day. Pas.e 2 of 4 will be made the following work M L-ops Pqid I Status Issued 225 Fifth Street, Springfield, OR 541-126-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 I nspection Line C Building/Combination Permit PERMIT NO: COM2006-01060ISSUED: 1010212006APPLIED: 08/1612006 EXPIRESz 0410212007VALUE: $ 242,000.00 Reouired Insnections Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed. Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in place but prior to concrete. Floor Insulation: Prior to decking. Shear Wall Nailing: Belbre covering sheathing with finish materials. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Final Building: After all required inspections have been requested and approved and the building is complete. Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill. Underfloor Plumbing: Prior to insulation or decking. Rough Plumbing: Prior to cover and including required testing. Underground Plumbing: Prior to filling the trench and including required testing. Rough Plumbing: Prior to cover and including required testing. Water Line: Prior to filling trench and including required testing. Sanitary Sewer Line: Prior to filling trench and including required testing. Storm Sewer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work is complete. Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete. Paee 3 of4 FIELD Building/Combination Permit Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541 -7 26-37 69 Inspection Line PERMIT NO: COM2006-01060ISSUED: 1010212006APPLIED: 08/1612006 EXPIRES: 0410212007VALUE: $ 242,000.00 By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the pe card is located at the front of the property, and the approved set of plans will remain on the site at all times d ring t; Owner r Signatu re Date u Page 4 of4 Construction Contractors Board 700 Summer St ltE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 5033784621 \ileb Address: www.ccb.state.or.us Address:38L o \f\TtrS \ f.A..a.r^or,. pu,". a*to /o/q>/o Permit #:Qo Issued by: Statement: Information Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residenttal building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: .-H 1. I own, reside in, or witl reside in the completed stnrcture- tr 2. I understand that I must become licensed as a construction conhactor if the structure is sold or offered for sale before or on completion. 3A. My general contractor is (Name)(ccB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR '[] 38. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Owners Responsibilities on the reverse side of this form. applicant) (White copy to issuing agency perrnitfile, pink copy to applicant.) ) Property_owner. doc 06-0 1 -04 Acting as Your Own General C6ntr'aetor? INFORMATION NOTICE TO PROPERTY OWNER$ ABOUT CONSTRUCTION RESPONSIBILITIES G If you are acting as your own contractor to construct a new home or make a substantial improvement structure. you can prevent many problans by being aware of the followihg rbsponsibilities ard concerns. Employer Responsibilities You wrll, in most instances, be ruled to be an "ernployer" and the contractors you contract with will be "employees" if you use conhactors not licensed with the Conskuction Contractors Boara to do iabor in constructing or to assist in the construction or,improvement of a residsntial structure. As the employer, you must comply with the following: Oregon's Withhoiding Tax Law: As an employer, you must withhold income taxes from.ernployee wages at fhe time employees are paid. You will be liable for the tax payments even if you don't achrally withhoid the tax from your employees.Formoreinforrnation,call.theDeparhrrentofRevenueat503.3784988' Unemployment Insurance Tax: As an employer, you are required to pay a tax for unemploymant,.insurance purposej i on the wages of aii emgrloyees. For more inf*rmation, call the Oregon Employment Deparlmentat50S-947-1488. The Oregon Business ldentification Number Gn$ is a combined n*mber for both Oregou Withholding andUnemployrnent[nsuranceTax.Tofi1eforaBIN,call503-945-809lorforthe appropriate forms. Workerst Compensation fnsurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim [osts if one of your employees is injured on the job. For more information, call the Workers' Compensation Dvision'at the Department of Consumer add,Business Services at 5A3-947 -7815. U.S. Internal Revenue Service: As an employer, you must withhold federal incorne tax from'-emfiloyeel' wages. You will be liable for the tax payment even if you didn't actualiy withhold the tax. For a Federal EIN number, call the Other Responsibilities and Areas of Con0ern-$ ,: ..t: Code Compliance: As the permit holder for this project, you are responsibie for resolvin.g any *irui" to'meet code requirementstha.tmaybebroughttoyourattsntionthroughinspections.:,::i..i..: Liability and Property Damage fnsurance: Contact your insurance agent to see'if you trave ade[uate iiisuranct coverage for accidents and omissions such as fallir:g tocls, paint over spray, water damage from pipe punctures, fire or work that must be redone. Time: Make sure you'have suf{icient time to supervise your employees. . $ Expertise: Make sure you have the skills tb aci as your own gereral contractor, to *jordinate the work of rough-in and finish trades, and to notiff building officials as the appropriate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-37S4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. : ...) : , Properry*owner.doc 06-0 1 -04 NOfEj This lnformation Natics to Property Ownars about Canstruction Responsibilffies lvas developed by the Construction Contractors Board in accardance with ARS 7U.A55{5), passed by the 1989 Aregon Legislature. CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT Y,ORKSHEET JOURNAL OR JOB NUMBER: COM2006-01060 NAME ORCOMPANY: LOCATION: TAX LOTNUMBER: DEVELOPMENT TYPE: NEW DWELLING I.]MTS Robert &Williams 3860 Vitus r 702030000600 FAMILY RESIDENCE 0 BUILDING SZE DIRECT RLTNOFF TO CITY STORM SYSTEM 0 IMPERVIOUS S.F. x 2112.00 RUNOFF NUMBEROF DFU's 6 B.IMPROVEMENT COST: NT-IMBER OF DFU'S 6 B. IMPROVEMENT COST: ADTTRIP RATE 9.57 COST PER S.F $0.336 COST PER S.F s0.336 COST PER DFU $26.03 $19.79 NUMBER OF UNITS 0 NUMBER OF UNITS 0 ADM. FEE RATE 5% FEE: 8t3v7006 CHARGE $708.82 LOT SZE (SF): DISCOUNT $0.00 DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS x DISCOUNTRATE 50o/o $708.82 x x x ITEM 1 TOTAL - STORM DRAINAGE SDC 2. SANITARY SEWER- CIry A.COST: ITEM 2 TOTAL. CITY SANITARY SEWER SDC s274.90 3. TRANSPORTATION COST:A. xxx x COST PER TRIP $19.81 COST PER TRIP $87.39 $0.00 NEW TRIP FACTOR 1.00 NEW TRIP FACTOR 1.00 x ITEM 3 TOTAL - TRANSPORTATION SDC A. REIMBURSEMENTCOST: NUMBER OF FEU's 0 B.iMPROVEMENT COST: NUMBER OF FEU's 0 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIYE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC SUBTOTAL (ADD ITEMS I,2,3, & 4) x x SUBTOTAL $983.72 TOTAL TRANSPORTA s0.00 72 CHARGE s49. I 9 x Jeff Prociw TMPERVIOUS S.F 0.00 ADT TRIP RATE 9.57 s156. $0.00 $0.00 s0.00 49.1 $1,032.91 1070 l09l 1092 1093 1094 1055 1054 l 056 10'79 U) rr.laoU rr.lFa r! COST PER FEU s9l.6l COST PERFEU $961.52 PREPARED BY DATE TOTAL SDC CHARGES TOTAL SANITARY ADMINISTRATION FEE: x DRAINAGE FIXTURE UNIT CALCULATION TABLE NUMBER OF NEW FXTURES X UNIT EQUWALENT: DRAINAGE FXTURE TIMTS CALCULATE ONLY T}IE NET ADDITIONAL NO. OF FXTI.]RES TINIT FD(TURE TYPE NEW OLD MISCELLANEOUS DFU TYPE NUMBER OF EDU'S TOTAL DRAINAGE FD(TI]RE LINITS isa toa mit set at I 67 MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE 20 DRAINAGE FIXTURE LTNITS 0 2 t979 *EDU BEFORE 1979 $5.29 $5.29 $5.1 9 $5.12 $4,98 $4.80 $4.63 $4.40 $4 07 $3.67 s3.22 $2.73 $2.25 $1.80 IS LAND ELGIBLE FOR ANNEXATION CREDIT? (Enter t for Yes, 2 for No) IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? (Enter 1 for Yes, 2 for No) BASE YEAR CREDIT FOR LAND (IF APPLICABLE) 1979 1980 1981 1982 1983 r984 1985 1986 1987 1988 1989 1990 199 I 1992 1993 1994 1995 1996 r997 1998 1999 2001 2 VALUE / IOOO s0.00 CREDIT RATE s5.29x CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE / 1OOO CREDIT RATE $0.00 x $5.29 TOTAL }TWMC CREDTT$1.59 $1.45 $1.25 $1.09 $0.92 $o.72 $0.48 $0.28 $0.09 $0.05 0300 ,AINDRINKING TI{TT]B 0I00 0300FLOORDRAIN0300INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC 0600WASH/ETC.INTERCEPTORS FOR SAND /AUTO 0020LATINDRY TI.IB 0300CLOTHESWASHER/MOP SINK 0600CLOTMSWAS}IER - 3 OR MORE (EA) 01200MOBILE HOME PARK TRAP (1 PER 0010ATIONWATERETC.STREFRIGFORRECEPTOR 0300RECEPTORFOR COM.DISHWASHER/ETC.SINK/2201SINGLE STALL 0020SHOWER" GANG (NUMBER OF MADS) 3 000KITCHENSINK: 0200SINK: COMMERCIAL BAR 0200SINK: W BASIN/DOI'BLE LAV ATORY I110SINK: SINGLE LAVATORY /RESIDENTTAL BAR 0050URINAL, STALL / WALL 00b0TOILET, PUBLIC INSTALLATION 3 310TOILET. PRTVATE IN STALLATION YEAR ANNEXED CREDIT RATE/$I,OOO ASSESSED VALUE 00 0 00 2000 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone Ci6' of Springfield Official Receipt L .lopment Services Department Public Works Department RECEIPT #: 3200600000000000508 Date: 1010212006 2:32:l4PM Job/Journal Number coM2006-01060 coM2006-01060 coM2006-01060 coM2006-01060 coM2006-01060 coM2006-01060 coM2006-0 r060 coM2006-0 r060 coM2006-0 r060 coM2006-01060 coM2006-0 t060 coM2006-01060 coM2006-01060 coM2006-01060 coM2006-01060 coM2006-0 r 060 Description Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Sanitary/Storm Admin Building Permit Fixture Sanitary Sewer - I st 50 Feet Water Line - lst 50 Feet Storm Sewer - lst 50 Feet Vent Fan M in imum/Adjustment Mechan ical -Mechanical Issuance Fee- + 5%o Technology Fee + 8% State Surcharge + lloh Administrative Fee Plan Review Minor - Planning Amount Due 708,82 1 56.1 6 I18,74 49.t9 t,027 .t5 42.00 45.00 45.00 4s.00 6.00 39.00 10.00 62.46 99.93 t24.92 I12.00 Item Total:s2;691J7 Payments: Type of Payment Paid By Received By Check Number Batch Number Authorization Number How Received Amount Paid Check ROBERT G. FABRICK njm 4268 In Person $2,691.37 Payment Total: -Sffi c R eceint I Page I of I 10t212006 tDllwr3e 225 FIFTH STREET . SPRINGFIELD,ORII4TT . PH:(541)726-ll$l r FAX: (541)726-3689 E LECTRICAL P ERMIT AP P LI CATI AN Ciry Job Number 0-Prr^-a,o robo zoN INITIALS DATE SOURCE Date b 3. COXIPLETE FEE SCHEDTJLE BELO\,\r A. Nerv Residential - Single or l\Iulti-tranrily per drvelling unit' Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof I $106.00 $ 19.00 -(.- $s0.00 ation, Alterations or Relocation: $ 63.00 b) $ 7s.00 $ 125.00 $163.00 s37s.00 $ s0.00 $ s0.00 s 69.00 $100.00 s 43.00 $ 3.00 I o LEGAL DESCRIPTIbN iY L36 ooo bm JOB DESCRIPTION A/r)L!-< e,a- Ciry Supervisor License Expiration Constr. Contr Expiration Signature Supervising Electrician 601 Amps to 1000 AmPs Ovei t000 Amps/Volts Reconnect Only 8% State Surcharge l0% Administrative Fee 5% TechnologY Fee Address OWNER INSTALLATION The installation is being made on property I own which is not intended sale, lease or rent. Installation, Alteration or Relocation 2oo arnps or less 201 Amps to {00 AmPs 401 Amis to 600 AmPs Over 600 Amps or 1900 Volts see "B" above. D. Branch Circuits New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit E. Nliscellaneous (Service/feedernot included) -Each Install:rtion pt on" tl 3Lo \-ll tO Pump or irrigation s 50.00 q5 3 -q191 SUBTOTAL OF ABOVE (,'a. "' 5.c t o , 77+LInspection Request: 726-37 69 4. TOTAL Shared Drive(T:)/Building Forrns/Electrical f .nolt eppti*tffi OdAo' SPBINGFIELD.., :..] ;.-;,..,, " Afr, ' q Lo--rt:.--' Permits are not started within 180 daYs Suspended for 180 days. )CONTRACTOR Electrical Contractor Address /o a '(*, n> owners Nane ( O WSt en- t Ootz Lr-t, I I wt',n4 Sign/Outline Lighting $ 50'00 Limited Energy/Residential S 25'00 Limited Energy/Commercial $ 45'00 Minimum Electric Permit Inspection Fee is $45'00 .| Surcharges Construction Contractors Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 lVebAddress: !Ery.cc$!g!e.or.ug Permit #:(uro**to -Oto GO Address: 38bo V'**s Lo-" Issued by:'tla-i pu6, 8- /L'ol- E N Statement: lnformation Notice to Property Owners About Gonstruction Responsibi Iities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and -plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and 2, md either box 3A or 38: m l. I own, reside in, or will reside in the completed structure- Z. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. 3A. My general conhactor is (Name)(ccB #) I will instruct my general conhactor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR E 38. I will be my own general contractor. If I hire subcontractors,I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notiff the office issuing this building permit of the name of the conEactor. I hereby certify that the above information is correct and that I have read and do understand the Information N to Owners about Construction Responsibilities on the reverse side of this form. Itt (Signature of permit apPlicant) (White copy to issuing agenq) pennitfile, pink copy to applicant') ) Property_owner.doc 06-0 I -04 Acting as Your Own General Cd'ntractor? INFORMATION NOTICE TO PROPERTY OWNERS ABOUT CONSTRUCTION RESPONSIBILITIES NOIE; Tltis lnformation Natice to Propefty Owners abaut Construction Responslbi/rfies lyas developed by the Construction Contractors Board in accardance with ARS 7U.A55(5J, passed by the lg89 Oregon Legislature. If you are acting as your own conkactor to construct a new home or make a substantial improvement to an exrstmg structure, you can prevent many problems by being aware of the following responsibilities and concsrns. Employer Responsibitities You will, in most icstances, be ruled to be an "employer" and the conhactors you contract with will be ';employees" if you use contractors,not licensed with the Construction Conkactors Board to do iabor ia constructilrg.or to assist in the construction or improvement of a residential structure. As the employer, you must comply witt tnrittillowing: Oregor's Withholding Tax Law: As an employer, you must withhold income taxes frorn employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your empioyees. For more information, call the Department of Revenue at 503-378-4988. i : Unemployment Insurance Tax: As an erryloyer, you ite required to pay a tax for unemployment insurance purpose[-.] on the wages of all employees. For mcre information, cail the Oregon Hmployment Department at 503-94?-1488. The Oregon Business ldentification Nurnber EIIII) is a combined number for both, Oregon lilitirkolding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or wyw.dor.state.or.us/formspay.hfinl.l for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on thejob. For more information, call the Workers' Compensation Division at the Deparh'ent of'Consumer and Business Services at 5A3 -947 -7 8'1, 5 . U.S. fnternal Revenue Service: As an employer, you must withhold federal income tax &om bmploy€es' *,ag.iX: You will be liable for the tax payment even if you didn't actually withhold the tax" For a Federal EIN number, call the IRS at tr-800-8294933 or visit their web site at Llgtr'.i$,ggy Other Responsibilities and Areas of Concerns Code Compliance: As the permit holder for this project, you are responsible for resolving dty failure to meet code requirements that may be brought to your attention through inspections Liability and Property Damage fnsurance: Contact your insurahce agent to see'if you have,adequ:dte instrraa|€r!' coverage for accidents and ornissions such as falling tools, paint over spray, water damage fiom pipe punchrres, fire or work that must be redone. Time: Makesureyouhavesufficienttimetosuperviseyouremployees. ,:''.i,r: r . ,. ,.1,. Expertise: Make sure you have the skills to act as your own general contractor, to eooidiriate the work of rough-in and finish trades, and to notify building officials as the appropriate times so they can perform the required inspections" If you have additional questions call the Construction Contractors Board (503-3784621) or write the agency at p0 - ti' .Jt.,'). :.:.) Box 14140, Salem, OR 97309-5052. Properfy_oumer.doc 06-0 I -04 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone Ci'' of Springfield Official Receipt L elopment Services Department Public Works Department RECEIPT #: 1200600000000001275 Date: 0811612006 8:46:50AM Job/Journal Number coM2006-01060 coM2006-01060 coM2006-0r060 coM2006-01060 coM2006-01060 Description Plan Review Residential Perm Serv/Fdr 200 amps or less + 8% State Surcharge + 10oh Administrative Fee + 5%o Technology Fee Amount Due 243.46 63.00 5.04 6.30 3.r5 -5320-3t Item Total Payments: Type of Payment Paid By Received By Check Number Batch Number Authorization Number How Received Amount Paid Check ROBERT FABRICK& LANESIA WILLIAMS lkw 4253 In Person Payment Total: $320.95 $320.95 cReceint I Page I of I 811812006 *FE!r!,&Fl*f.{}